Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Preliminary Cost-Effectiveness Analysis in the Italian Context

Background: Cardiogenic shock (CS) is a life-threatening failure of the heart to supply adequate blood, requiring immediate treatment. Although nowadays Impella® heart pumps and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) are both widely employed in routine clinical practice for the management of patients with CS, extensive comparative information on their cost-effectiveness is lacking. The aim of the present study was to conduct a cost-effectiveness analysis comparing Impella to VA-ECMO in patients with CS from the National Healthcare Service (NHS) perspective in Italy. A secondary objective was to compare costs from both NHS and hospital perspectives. Methods: A Markov model projected, on a lifetime horizon, life years (LYs), quality-adjusted life years (QALYs) and costs associated with Impella and VA-ECMO. Costs from the NHS perspective were estimated mainly through Italian reimbursement rates, while hospital costs were derived from a clinical center in Italy. Results: From the NHS perspective, Impella showed lower costs and better life expectancy and patients’ quality of life (50,303€, 1.544 LYs, 0.905 QALYs) compared to VA-ECMO (76,795€, 1.391 LYs, 0.784 QALYs). DRG overall reimbursements for Impella (49,998€) do not completely cover the hospital costs and the cost for the technology (57,770€). Conversely, the hospital cost for the strategy VA-ECMO (52,190€) is lower compared to the NHS overall reimbursements (76,790€). Conclusions: Our analysis suggests that Impella may be cost-saving over VA-ECMO, whilst also providing better health outcomes for patients with CS; however discrepancies in costs and reimbursement rates were observed, likely due to variability in patient care and hospital resource utilization. Future real-world studies are needed to confirm these findings, but decision-makers can use this data as initial reference for health technology assessments in Italy.